Background and Purpose

Expert consensus guidelines recommend optimizing global risk factor control in diabetic stroke survivors to improve outcomes. Since relatively little is known about the adequacy of risk factor control among diabetic stroke survivors in sub-Saharan Africa, we sought to assess control rates of key traditional risk factors among Ghanaian stroke survivors with diabetes. A secondary objective was to assess the burden of undiagnosed dysglycemic states among stroke survivors without a prior diagnosis of diabetes mellitus (DM)

Methods

Cross-sectional study of outpatient stroke survivors consecutively enrolled in a stroke registry at a tertiary medical center in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details including blood pressure, lipid panel, fasting blood glucose results, medications prescribed for secondary prevention, and stroke type information. BP control target was set at <130/80 mmHg, LDL-cholesterol <2.6 mmol/l and Fasting blood glucose (FBG) <7.0 mmol/l. Factors associated with poor control of vascular risk factors were assessed using multivariate logistic regression models.

Results

Of 1101 stroke survivors enrolled into the registry, 279 (25.3%) had a comorbid diagnosis of DM. Mean (±SD) age among the diabetic vs. non-diabetic stroke patients was 61.4 ± 12.0 years vs. 57.6 ± 14.6 years (p < 0.0001). Among the diabetic stroke patients, 61.7% had LDL-cholesterol <2.6 mmol/L, 8.2% had BP <130/80 mm Hg and 28.6% had FBG <7.0 mmol/L. Significant predictors of poor control of BP were younger age, having co-morbid DM and number of antihypertensive medication classes while poor LDL-cholesterol was associated with longer duration of stroke diagnosis. Among those without a prior diagnosis of DM, FBG analysis of 540 subjects with available data showed that 21.7% had FBG <5.7 mmol/L, 39.0% had impaired fasting blood glucose and 39.3% had FBG in the diabetes mellitus range. Patients who were older, female, or experienced an ischemic stroke trended towards being more likely to have undiagnosed DM.

Conclusion

Among Ghanaian diabetic stroke survivors, blood pressure and blood glucose, are especially poorly controlled. There is also a high burden of undiagnosed pre-diabetes and DM among stroke survivors substantially heightening their risk for further adverse CVD outcomes.

中文翻译：

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患有中风和糖尿病的卒中幸存者的危险因素控制：加纳注册表分析

背景和目的

专家共识指南建议优化糖尿病性卒中幸存者的总体危险因素控制，以改善预后。由于对撒哈拉以南非洲地区糖尿病中风幸存者中危险因素控制的适当性知之甚少，我们试图评估加纳糖尿病中风幸存者中关键传统危险因素的控制率。次要目标是评估未事先诊断出糖尿病（DM）的中风幸存者中未诊断的血糖异常状态的负担

方法

在2018年1月至2020年3月之间，连续在加纳的一家三级医疗中心登记卒中登记的门诊卒中幸存者的横断面研究。我们收集了基线人口统计学和临床​​细节，包括血压，血脂指标，空腹血糖结果，处方药二级预防和中风类型信息。BP控制目标设定为<130/80 mmHg，LDL-胆固醇<2.6 mmol / l，空腹血糖（FBG）<7.0 mmol / l。使用多因素逻辑回归模型评估与血管危险因素控制不良相关的因素。

结果

在登记的1101名卒中幸存者中，有279名（25.3％）患有DM合并症。糖尿病与非糖尿病性卒中患者的平均（±SD）年龄为61.4±12.0岁，而57.6±14.6岁（p <0.0001）。在糖尿病中风患者中，低密度脂蛋白胆固醇<2.6 mmol / L占61.7％，血压<130/80 mm Hg占8.2％，FBG <7.0 mmol / L占28.6％。血压控制不佳的重要预测因素是年龄偏低，患有合并性糖尿病和降压药物类别的数量，而低密度脂蛋白胆固醇则与中风诊断时间更长有关。在未事先诊断为DM的那些患者中，对540名受试者的FBG分析显示，在糖尿病范围内，有21.7％的FBG <5.7 mmol / L，39.0％的空腹血糖受损，39.3％的FBG。年龄较大，女性或经历缺血性中风的患者倾向于更可能患有未确诊的DM。

结论

在加纳的糖尿病中风幸存者中，血压和血糖的控制尤其差。在中风幸存者中，未诊断的糖尿病前期和糖尿病的负担也很高，大大增加了他们进一步发生不良CVD结果的风险。